custom form needed that ties in with OC

For a client I am building an OC store (Daniel, I will donate to you as soon as my customer pays me)

I need the following:

Online form where a customer can fill out what type of light bulbs and fixtures he/she has in his/her house

example:
6x Big fitting, 60 watt
4x small fitting, 20 watt

The form should then go into the product d/base and select replacement products based on those values.
From the suggestions, the customer can select which one they want (color, etc) and add to cart

Please contact me if you can do this and how much you would charge.

Thanks!

Taco